Organization
DEARBORN FAMILY PHARMACY LLC
Active
Other names
Family Pharmacy LTC
Organization subpart
No
Provider details
NPI number
Authorized official
AIMAN ABUEIDA (OWNER)
(313) 523-5334
Entity
Organization
Contact information
Practice address
17000 EXECUTIVE PLAZA DR, SUITE 104, DEARBORN, MI 48126-2610
(313) 982-3770
(313) 982-3771
Mailing address
17000 EXECUTIVE PLAZA DR, SUITE 104, DEARBORN, MI 48126-2610
(313) 982-3770
(313) 982-3771
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
5301009879
MI
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2377237
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/23/2012
Last updated
09/22/2014
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